Original Paper

Digestive Diseases and Sciences

, Volume 53, Issue 3, pp 760-764

Squamous Dysplasia of the Rectum in a Patient with Ulcerative Colitis Treated with 6-Mercaptopurine

  • Rachel GreenbergAffiliated withDepartment of Medicine, University of Maryland School of Medicine
  • , Bruce GreenwaldAffiliated withDepartment of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine
  • , J. Scott RothAffiliated withDepartment of Surgery, Division of General Surgery, University of Maryland School of Medicine
  • , Olga IoffeAffiliated withDepartment of Pathology, University of Maryland School of Medicine
  • , Raymond CrossAffiliated withDepartment of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of MedicineVeterans Affairs, Maryland Heath Care System Email author 

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Abstract

Human papilloma virus (HPV) has been found to be a precursor and risk factor for both cervical and anal dysplasia. Cervical dysplasia, which is the precursor to carcinoma, is associated with immunosuppression from a variety of causes; reports of anal dysplasia associated with immune suppression exist as well. A recent study published in abstract form only demonstrated that women with inflammatory bowel disease (IBD) had high rates of cervical dysplasia and that those on immune suppressants had even higher rates of dysplasia. We report a case of a 50-year-old woman with refractory ulcerative colitis chronically treated with 6-mercaptopurine that developed severe squamous dysplasia of the rectum. The dysplastic mucosa was found to be positive for p16 (associated with high-risk HPV) after immunostaining. A total colectomy was performed. This case highlights the importance of immune suppression in the development of dysplasia of the anus/cervix secondary to HPV infection.

Keywords

Inflammatory bowel disease Ulcerative colitis Human papilloma virus Immune suppressants Anal cancer